Natural history of fever following seizure.

Generalized tonic-clonic seizure, like vigorous exercise, can cause a rise in body temperature. To describe the course of fever following a generalized seizure, the temperature curves of 93 hospitalized postictal patients were reviewed retrospectively. Forty patients (43%) had an elevation of body temperature above 37.8 degrees C (100 degrees F). No underlying infectious illness was identified in two thirds of the febrile patients, 89% of whom had become and remained afebrile by 48 hours. One third of the febrile patients who did have an infection were still febrile after 48 hours. This finding may help clinicians determine the timing of appropriate tests to rule out infections during the postictal period.

Cost-effective management of dyspepsia and gastroesophageal reflux disease.

Dyspepsia and heartburn are common symptoms in primary care practice. This article outlines the diagnosis and management of these problems with an emphasis on cost-effectiveness as well as the prevention of complications. It reviews what evaluations and treatments have been shown in the literature to be helpful and which have been found to be ineffective or much more expensive without clear benefit. It also clarifies the various diseases that can present as dyspepsia and refers readers to the appropriate articles included in this book.

Drug-induced meningitis. A case involving trimethoprim-sulfamethoxazole.

Drug-induced meningitis should be considered in differential diagnosis of meningeal irritation in patients receiving therapy with anti-infective, nonsteroidal anti-inflammatory, immunosuppressive, or other selected agents. This report describes a case of aseptic meningitis associated with use of trimethoprim-sulfamethoxazole in a patient without apparent underlying autoimmune disease. The patient recovered promptly after the offending agent was withdrawn. No specific treatment other than symptomatic and supportive care need be given. In all instances, however, infection must be excluded.

Impact of intensive lipid modulation on angiographically defined coronary disease: clinical implications.

We reviewed all randomized, controlled angiographic trials to assess the impact of intensive lipid modulation on the progression or regression of angiographically defined coronary disease. Five of seven trials satisfied selection criteria: Cholesterol-Lowering Atherosclerosis Study, Program on the Surgical Control of the Hyperlipidemias, Familial Atherosclerosis Treatment Study, Regression of Coronary Atherosclerosis During Treatment of Familial Hypercholesterolemia, and St. Thomas' Atherosclerosis Regression Study. We compared patient selection, baseline and on-trial lipid values, changes in angiographic disease scores, and clinical outcomes. In all five trials, treatment reduced levels of low-density lipoprotein (LDL) cholesterol substantially (range -32% to -46%). Treatment reduced risk of angiographic progression by almost 50% compared to controls. Furthermore, nearly one third of drug-treated patients showed angiographic regression of disease. Regression correlated well with reduction in LDL cholesterol. Although overall improvement in stenosis was modest, reduction in clinical events was impressive. Intensive lipid modulation may "stabilize" existing lesions, making them less "active" (ie, less prone to rupture or thrombosis), thereby reducing risk of acute coronary syndromes. These studies clearly support intensive lipid modulation in patients with established coronary disease.